Reported symptoms of food hypersensitivity and sensitization to common foods in 4-year-old children

AIM: To characterize reported food hypersensitivity (FHS) among young children in a birth cohort. METHODS: At 4 years of age a parental questionnaire on FHS and allergic symptoms was evaluated. Blood was collected for analyses of IgE-antibodies to egg, milk, fish, wheat, peanut and soy. Complete questionnaire data was available for 3694 children (90%), and blood samples were obtained from 2563 children (63%). RESULTS: FHS was reported in 11% of the children (n=397). Eczema was the most commonly reported symptom and the only symptom in half of these children. Food-related reactions from the airways, facial oedema or urticaria were reported in 198 children, and the majority of these children (75%) reported multiple symptoms. Furthermore, a combination of airway symptoms, facial oedema or urticaria together with sensitization to food suggested a more severe form of FHS. This was found in 1.6% of all children. Symptoms caused by peanut were closely associated with sensitization to peanut (p<0.001). CONCLUSIONS: FHS in 4-year-old children with any of asthma, rhino-conjunctivitis, facial oedema or urticaria in combination is in most cases associated to sensitization to food. This phenotype of FHS is likely to represent a more severe form of FHS.     

白细胞介素10受体1在食物过敏儿童外周血T淋巴细胞中的表达

目的　研究白细胞介素10受体1（IL-10R1）在食物过敏儿童外周血T淋巴细胞的表达及其临床意义。方法　选择2017-07-01至2017-12-31在北京大学第三医院儿科食物过敏门诊诊断为食物过敏的50例患儿作为食物过敏组,选择同期在北京大学第三医院儿童健康发展中心行健康体检的25名儿童作为对照组。采用流式细胞技术检测IL-10R1在两组儿童外周血CD4+T及CD8+T淋巴细胞表达阳性率及平均荧光强度值（MFI）。同时比较IL-10R1在过敏原特异性IgE阳性与阴性食物过敏患儿外周血CD4+T及CD8+T淋巴细胞表达阳性率及MFI。根据食物过敏患儿症状、体征严重程度进行赋值评分,分析食物过敏患儿IL-10R1在外周血CD4+T及CD8+T淋巴细胞表达阳性率与食物过敏症状、体征评分有无相关性。结果　IL-10R1在食物过敏组患儿外周血CD4+T及 CD8+T淋巴细胞表达阳性率和MFI均低于对照组,IL-10R1在食物过敏组CD4+T淋巴细胞表达阳性率和MFI中位数分别为40.23、 12.18; 在对照组CD4+T淋巴细胞表达阳性率和MFI中位数分别为45.32、 17.69（Z值分别为-2.506、 -5.457;P值分别为0.012、 0.000）。IL-10R1在食物过敏组CD8+T淋巴细胞表达阳性率和MFI中位数分别为34.50、 12.47;对照组CD8+T淋巴细胞IL-10R1表达阳性率和MFI中位数分别为39.46、 17.28（Z值分别为-4.035、 -5.226; P值分别为0.000、 0.000）。IL-10R1在过敏原特异性IgE阳性与阴性患儿外周血CD4+T及CD8+T淋巴细胞表达阳性率及MFI没有差异。食物过敏患儿IL-10R1在外周血CD4+T及CD8+T淋巴细胞表达阳性率与食物过敏症状、体征评分无相关性。结论　IL-10R1在外周血CD4+T淋巴细胞和CD8+T淋巴细胞表面表达减少可能与食物过敏发病有关;IL-10R1在外周血CD4+T淋巴细胞和CD8+T淋巴细胞表面表达在IgE和非IgE介导的食物过敏发病过程中均起作用;IL-10R1在外周血CD4+T淋巴细胞和CD8+T淋巴细胞表面表达可能与食物过敏发病严重程度无关。     

Increase in atopic sensitization rate among Dutch children with symptoms of allergic disease between 1994 and 2014

Background

The prevalence of symptoms of allergic diseases has increased significantly during the last decades. However, studies into time trends of atopic sensitization among children are limited and have focused on aeroallergen sensitization. We aimed to investigate time trends in the prevalence and degree of atopic sensitization to inhalant and food allergens among children (0‐17 years) with symptoms of allergic disease.

Methods

Sensitization data of all children tested in our clinical laboratory during 1994‐2014 were analyzed. Sensitization was detected using the ImmunoCAP system and defined as a specific IgE level of ≥0.35 kU/L. Trends in sensitization rates to 5 food and 5 aeroallergens for different age categories were investigated with logistic regression, adjusted for age and sex.

Results

Sensitization data of 18 199 children were analyzed. Between 1994 and 2014, a steady and statistically significant increase in overall sensitization rate was found (from 40.5% in 1994 to 48.9% in 2014, adjusted odds ratio [aOR] 1.01 per year, 95% confidence interval [CI] 1.00 to 1.01, P = .003). This increase in sensitization rate was mainly explained by increasing aeroallergen sensitization among 4‐ to 11‐year‐old children (aOR 1.02, 95% CI 1.01 to 1.02, P < .001). We found no increase in sensitization rates to food and aeroallergens in other age categories. The degree of sensitization did not change significantly during the study period (all tests P > .15).

Conclusion

We observed a statistically significant increase in sensitization rate between 1994 and 2014 among children with symptoms of allergic disease. This was mainly explained by increasing aeroallergen sensitization among 4‐ to 11‐year‐olds.     

Concentrations of cat (Fel d 1), dog (Can f 1) and mite (Der f 1 and Der p 1) allergens in the clothing and school environment of Swedish schoolchildren with and without pets at home

To investigate whether our hypothesis that cat and dog owners bring allergens to public areas in their clothes was true or not, we studied the levels of Fel d 1, Can f 1, Der p 1 and Der f 1 in dust from the clothes and classrooms of children in a Swedish school. We also investigated the levels of allergen in different areas in the four classrooms used by the children. Thirty-one children were selected in four classes, forming three groups: cat owners, dog owners and children without a cat or dog at home. Furthermore, a group of children with asthma was included. Cat and dog allergens were detected in all 57 samples from clothes and classrooms. Mite allergen Der f 1 was detected in low concentrations in 6 out of 48 and Der p 1 in 5 out of 46 samples investigated. The concentrations of Can f 1 were higher than those of Fel d 1 in samples from clothes (geometric mean: 2676 ng/g fine dust and 444 ng/g) and classrooms (Can f 1: 1092 ng/g, Fel d 1: 240 ng/g). The dog owners had significantly higher concentrations of Can f 1 (8434 ng/g fine dust) in their clothes than cat owners (1629 ng/g, p <0.01), children without cat or dog (2742 ng/g, p < 0.05) and children with asthma (1518 ng/g, p < 0.001). The cat owners did not have significantly higher levels of Fel d 1 (1105 ng/g) in their clothes compared to the other three groups (D: 247 ng/g, nCnD: 418 ng/g, A: 386 ng/g) but the levels were significantly higher than for all children without a cat at home (345 ng/g, p < 0.05). No concentrations of mite allergen and low concentrations of Fel d 1 and Can f 1 were found in the children's hair. There were significantly higher concentrations of Fel d 1 and Can f 1 in dust from curtains than in samples from floors and bookshelves (p < 0.05). There was no significant difference between the allergen concentrations in samples from curtains and from desks and chairs, including the teachers' chairs, the only upholstered furniture in the rooms. Our results support the hypothesis that cat and dog owners bring allergens to public areas in their clothes and support other studies showing that textiles and upholstered furniture function as reservoirs of cat and dog allergens. Thus, children with asthma and other allergic diseases will be exposed to cat and dog allergens at school and by contact with pet owners, even if they avoid animal allergens at home.     

Latex type I sensitization and allergy in children with atopic dermatitis. Evaluation of cross‐reactivity to some foods

Recent studies have demonstrated that allergy to natural rubber latex (NRL) is associated with cross-reactivity to certain foods. The aim of this study was to investigate the prevalence of NRL sensitization and allergy in children with atopic dermatitis (n=74). We also examined cross-reactions between latex and foods, and compared the frequency of suspected latex cross-reacting fruits in children with and without NRL-specific immunoglobulin E (IgE). Twelve of the 74 atopic children studied (16.2%; 95% confidence interval (CI), 8.7–26.6%) had circulating IgE antibodies to latex. These NRL-sensitized children were older and they showed significantly higher total IgE values (p<0.003) when compared with the group of children without NRL sensitization. Of the specific food IgE evaluations, 18.4% (93 out of 505) were positive, and 69.9% were observed in the group of children with latex-specific IgE, most frequently to potato, tomato, sweet pepper, and avocado. An isolated latex-specific IgE response without food-specific IgE was never observed. Exclusively in the latex-positive group, conformity with the report of allergic symptoms after ingestion of food and increased food-specific IgE was found. Twenty children without proven latex sensitization showed increased food-specific IgE, most frequently to potato, banana, and chestnut. Avocado-specific IgE was never determined in this patient group. No significant differences were detected concerning the sensitization to potato, banana, and kiwi between NRL-sensitized children and the group of 20 children without latex-specific IgE. The competitive CAP inhibition using sera from children with specific IgE to both latex and food showed different cross-reactivities between latex and the specific food. A close relationship existed between latex and avocado (median inhibition: 100%), whereas sensitization to latex and kiwi seemed to be independent in our study group (inhibition: <25%). In particular, for potato, cross-reactivity and co-sensitization existed. Our study demonstrated that children with atopic dermatitis are a high-risk group for latex sensitization. Increasing age, additional sensitization to ubiquitous inhaled allergens, and enhanced total serum IgE values seemed to be important variables for latex sensitization and further sensitization to the latex-associated foods. Cross-reactivity and, in some cases, co-sensitization to specific fruits and vegetables, were observed.     

Influence of SNPs in cytokine-related genes on the severity of food allergy and atopic eczema in children

Although many single nucleotide polymorphism (SNP) studies have reported an association of atopy, allergic diseases and total serum immunoglobulin E (IgE) levels, almost all of these studies sought risk factors for the onset of these allergic diseases. Furthermore, many studies have analyzed a single gene and hardly any have analyzed environmental factors. In these analyses, the results could be masked and the effects of other genes and environmental factors may be decreased. Here, we described the correlation between four genes [interleukin (IL)-4 (C-590T), IL-4 receptor (A1652G), FCER1B (G6842A) and STAT6 (G2964A)] in connection with IgE production; the role of IL-10 (C-627A) as a regulatory cytokine of allergy; and the severity of food allergy (FA) and atopic eczema (AE) in 220 Japanese allergic children. In addition to these SNPs, environmental factors, i.e., patient's attitude, indoor environment, and so on, were also investigated in this study. Our study was retrospective, and the correlation was analyzed by our defined clinical scores divided into three terms: worst symptoms, recent symptoms and general amelioration at the most recent examination during the disease course. Our results indicated that IL-10 AA, the genotype with lower IL-10 production, is associated with higher IgE levels in the serum (p < 0.0001, estimate; 0.912). Marginal liver abnormalities were observed in the subject group with both FA and AE (p < 0.1191, estimate; 0.1490). Our defined clinical scores enabled evaluation of various aspects of disease severity. Based on the scores, while no single SNP selected in this study determined severity, the combination of the SNP with laboratory data and environmental factors appeared to determine severity.     

Genetic and environmental factors affecting the development of atopy through age 4 in children of atopic parents: a prospective randomized study of food allergen avoidance

The effect of food allergen avoidance, as well as other environmental and genetic factors, on the development of atopy were determined in this follow-up report of a prospective randomized controlled study of 288 infants of atopic parents, in which 78% were available for evaluation at age 4 years. The prophylactictreated group consisted of mothers who avoided cow milk. egg. and peanut during the last trimester of pregnancy and lactation and of infants who avoided cow milk until 1 year (casein hydrolysate supplementation prior to 1 year) and egg, peanut, and fish until after 2 years. The control group consisted of maternal/infant pairs who followed standard feeding practices. The cumulative prevalence of food allergy and food sensitization remained lower in the prophylactic treated group from 1 to 4 years of age. However, the period (current) prevalence of food allergy in both study groups was similar (about 5%) at 3 and 4 years. Such findings suggest that period prevalence may represent the more appropriate measure to assess the impact of intervention measures on the development of atopic disease at older ages. Prophylactic-treated children evidenced lower levels of IgG beta lacloglobulin (BLG) at 4 months and I and 2 years (p < 0.0001) and lower IgG ovalbumen/ovomucoid (OVA) levels only at 2 years (p < 0.001). Both groups evidenced similar prevalences of asthma, allergic rhinitis, and positive inhalant skin tests from birth to 4 years. Children with food allergy evidenced higher 4 year cumulative prevalences of allergic rhinitis and asthma (p < 0.05). Risk factors for atopic disease by age 4 years were shown by multivariate analysis (p < 0.05) to include (1) unrestricted diet and elevated cord blood IgE with food allergy, (2) male gender and lower paternal level of education with asthma, and (3) non-caucasian ethnicity and spring/summer birth with atopic dermatitis and allergic rhinitis. Serum IgE levels were not significantly different between groups at 3 and 4 years, despite their being a trend towards lower serum IgE levels in the prophylactic-treated group at 4 months (p < 0.07). In the control group, formula feeding prior to 4 months was associated with higher 4 month serum IgE levels (p < 0.05). Stepwise linear regression revealed that serum IgE variability from birth to 4 years was influenced by male gender, non-caucasian ethnicity, maternal and paternal serum IgE levels, 4 month IgG BLG levels, positive food and inhalant skin tests, and the development of atopic dermatitis, food allergy, asthma, and allergic rhinitis. These findings demonstrate the strength of genetic factors and their modulation by dietary and envi-ronmental influences in the development of atopy and reveal that the reduction in food allergy in infancy by maternal/infant food allergen avoidance fails to affect respiratory allergy development from birth to 4 years.     

Food allergy knowledge,attitudes, and beliefs of parents with food‐allergic children in the United States

Gupta RS, Springston EE, Smith B, Kim JS, Pongracic JA, Wang X, Holl J. Food allergy knowledge, attitudes, and beliefs of parents with food‐allergic children in the United States.
Pediatr Allergy Immunol 2010: 21: 927–934.
© 2010 John Wiley & Sons A/S Parents of food‐allergic children are responsible for risk assessment and management of their child’s condition. Such practices are likely informed by parental knowledge, attitudes, and beliefs of food allergy. Our objective was to characterize food allergy knowledge and perceptions among parents with food‐allergic children. Parents were recruited nationally between January 2008 and 2009 to complete the validated, web‐based Chicago Food Allergy Research Survey for Parents of Children with Food Allergy. Findings were analyzed to provide composite/itemized knowledge scores, describe attitudes and beliefs, and examine the effects of participant characteristics on response. A sample of 2945 parents was obtained. Participants had an average knowledge score of 75% correct (range 19–100%). Strengths were observed in each content domain; e.g., 95% of participants accurately identified the signs of a milk‐induced reaction. Weaknesses were limited to items assessing food allergy triggers/environmental risks and perceptions of susceptibility/prevalence; e.g., 52% of parents incorrectly believed young children are at higher risk for fatal anaphylaxis than adolescents. Parental attitudes/beliefs were diverse, although 85% agreed children should carry an EpiPen at school and 91% felt schools should have staff trained in food allergy. One in four parents reported food allergy caused a strain on their marriage/relationship, and 40% reported experiencing hostility from other parents when trying to accommodate their child’s food allergy. In conclusion, parents in our study exhibited solid baseline knowledge although several important misconceptions were identified. While a broad spectrum of parental perceptions was observed, a large proportion of parents reported that their child’s food allergy had an adverse impact on personal relationships and also agreed on certain policies to address food allergy in schools.     

Positive skin and oral challenge responses to potato and occurrence of immunoglobulin E antibodies to patatin (Sol t 1) in infants with atopic dermatitis

The clinical significance and molecular specificity of hypersensitivity reactions to raw and cooked potatoes remain ambiguous. We therefore investigated the clinical hypersensitivity to raw and cooked potato in infants suspected to have potato allergy and compared the findings with the occurrence of immunoglobulin E (IgE) antibodies to patatin (Sol t 1), characterized as the primary allergen of potato. Twelve infants (10 to 24 months of age) suffering from atopic dermatitis (AD) and suspected to have adverse reactions to potato, were examined. As a skin exposure test we used rubbing with both raw and cooked potato, and used open oral challenge with cooked potato for 7 days. A special eczema scoring system (SCORAD) was used to assess the severity of symptoms and signs of AD. Skin-prick tests (SPTs) were performed with raw potato and natural Sol t 1, and serological studies included measurement of total serum IgE and IgE antibodies to Sol t 1, and potato radioallergosorbent testing (RAST). The skin-rubbing test with raw potato was positive in seven (58%) and the oral challenge positive in eight (67%) infants. One infant presented with an immediate reaction and seven with a delayed reaction, i.e. exacerbation of AD, after oral challenge responses to cooked potato. Nine (75%) infants had IgE antibodies to Sol t 1 in enzyme-linked immunosorbent assay (ELISA), and SPT to natural Sol t 1 was positive in six (50%) potato-allergic infants. In conclusion, we observed positive challenge responses to both raw and cooked potato in food-allergic atopic infants. The presence of IgE antibodies and concomitant positive SPTs to the heat-stable potato allergen, Sol t 1, suggest that cooked potato can be an allergenic food for infants suffering from AD.     

Markers of inflammation and bronchial reactivity in children with asthma, exposed to animal dander in school dust

Several studies have confirmed the presence of animal dander allergens in school dust but the effect of this indirect animal exposure on health has not been evaluated. In this study we investigated bronchial reactivity and markers of eosinophil activity and inflammation during two separate weeks of school in 10 children with mild asthma and a positive skin prick test to cat and dog. At the beginning and the end of the first week the children underwent bronchial challenges with methacholine, and at the beginning and the end of the second week they underwent nasal lavages (NAL) and induced sputum samplings. Blood and urine samples for analysis of inflammatory markers were obtained before and after both school weeks. Peak expiratory flow (PEF) and symptoms of asthma and allergy were recorded daily, and spirometry was performed on each visit. The exposure to animal dander allergens was estimated from dust samples obtained in the subjects' schools and homes. Bronchial sensitivity to methacholine increased in the week when this was measured. The proportion of eosinophils in peripheral blood, and urinary eosinophil protein X (EPX), decreased in both weeks. There was a trend towards an increase of eosinophil peroxidase (EPO) and myeloperoxidase (MPO) in sputum in the week when these proteins were measured. The concentrations of cat (Fel d1) and dog (Can f1) allergens were higher in dust collected in schools than in homes. Our results show that in children with mild asthma and animal dander allergy, there is a significantly increased bronchial sensitivity to methacholine after one school week. There is also a significant decrease in the number of circulating eosinophils and a trend towards an increase of sputum EPO, which could correlate with the early phase of eosinophil recruitment to the lungs. These effects may be related to the continuous exposure to animal allergens in school dust.     

重庆单中心2009至2011年急性呼吸道感染住院患儿2种甲型流感病毒检出情况及临床特征分析

目的了解重庆地区急性呼吸道感染住院患儿新型甲型H1N1流感病毒（S-OIVs）与季节性甲型流感病毒（IVA）检出情况及临床特征。方法收集2009年6月至2011年5月重庆医科大学附属儿童医院呼吸科急性呼吸道感染住院患儿鼻咽抽吸物（NPA）,采用荧光定量PCR技术检测S-OIVs和季节性IVA基因组RNA,分析流行特点和临床特征,并采用Logistic回归分析急性呼吸道感染进展为重症肺炎的危险因素。 结果共收集NPA标本1 074份,经PCR检测IVA阳性105份(9.8%),其中1.4%（15/1 074）为S-OIVs,8.4%（90/1 074）为季节性IVA。2种病毒阳性病例男女比例、年龄分布和平均住院天数差异均无统计学意义（P>0.05）。①S-OIVs在2009年夏季高发(11/15,73.3%),季节性IVA在2009年夏季(26/95,27.4%)、2010年夏季(22/95,23.2%)和2011年春季(25/95,26.3%)检出率明显高于其他各季节。②2种病毒阳性患儿临床症状、外周血WBC计数、CRP水平相当,S-OIVs阳性患儿重症毛细支气管炎1例（6.7%）,季节性IVA阳性患儿重症肺炎14例（15.6％）。③15份S-OIVs阳性标本中,单纯S-OIVs感染3份,合并其他病毒感染9份,痰培养阳性7份。90份季节性IVA阳性标本中,单纯季节性IVA感染21份,合并其他病毒感染42份,痰培养阳性10份。④心脏基础疾病（OR=13.60）、发生喘息（OR=6.82）和合并腺病毒感染（OR=6.21）为季节性IVA感染患儿进展为重症肺炎的危险因素。 结论重庆单中心急性呼吸道感染住院患儿S-OIVs检出率低于季节性IVA。S-OIVs和季节性IVA感染患儿均以下呼吸道感染为主。心脏基础疾病、喘息症状和合并腺病毒感染有可能是季节性IVA感染患儿进展为重症肺炎的危险因素。     

Evaluation of an association between gastrointestinal symptoms and cytokine production against common dietary proteins in children with autism spectrum disorders

OBJECTIVE: To evaluate an association between cytokine production with common dietary proteins as a marker of non-allergic food hypersensitivity (NFH) and gastrointestinal (GI) symptoms in young children with autism spectrum disorders (ASD). STUDY DESIGN: Peripheral blood mononuclear cells (PBMCs) were obtained from 109 ASD children with or without GI symptoms (GI [+] ASD, N = 75 and GI (-) ASD, N = 34], from children with NFH (N = 15), and control subjects (N = 19). Diarrhea and constipation were the major GI symptoms. We measured production of type 1 T-helper cells (Th1), type 2 T-helper cells (Th2), and regulatory cytokines by PBMCs stimulated with whole cow's milk protein (CMP), its major components (casein, beta-lactoglobulin, and alpha-lactoalbumin), gliadin, and soy. RESULTS: PBMCs obtained from GI (+) ASD children produced more tumor necrosis factor-alpha (TNF-alpha)/interleukin-12 (IL-12) than those obtained from control subjects with CMP, beta-lactoglobulin, and alpha-lactoalbumin, irrespective of objective GI symptoms. They also produced more TNF-alpha with gliadin, which was more frequently observed in the group with loose stools. PBMCs obtained from GI (-) ASD children produced more TNF-alpha/IL-12 with CMP than those from control subjects, but not with beta-lactoglobulin, alpha-lactoalbumin, or gliadin. Cytokine production with casein and soy were unremarkable. CONCLUSION: A high prevalence of elevated TNF-alpha/IL-12 production by GI (+) ASD PBMCs with CMP and its major components indicates a role of NFH in GI symptoms observed in children with ASD.